Provider Demographics
NPI:1265493738
Name:TRUDEL, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:TRUDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-5408
Mailing Address - Country:US
Mailing Address - Phone:508-871-0700
Mailing Address - Fax:508-616-4411
Practice Address - Street 1:900 UNION ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-5408
Practice Address - Country:US
Practice Address - Phone:508-871-0700
Practice Address - Fax:508-616-4411
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
91114OtherFALLON COMMUNITY HEALTH P
AA1187OtherHARVARD PILGRIM HEALTHCAR
J14750OtherMEDICARE B
27004OtherHEALTHY START
0100296OtherEVERCARE
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherPRIVATE HEALTHCARE SYSTEM
27004OtherCHILDRENS MEDICAL SECURIT
4666601OtherCIGNA HEALTH PLAN
J14750OtherBLUE SHIELD HMO BLUE
5565516OtherAETNA US HEALTHCARE
784204OtherMVP HEALTH CARE
934715OtherFIRST HEALTH
3130720OtherMEDICAID WELFARE
J14750OtherBLUE SHIELD INDEMNITY
MA3130720Medicaid
J14750OtherBLUE CARE ELECT
27004OtherHEALTHY START
934715OtherFIRST HEALTH